Where do the presidential candidates stand on health care?

WASHINGTON — About 9 in 10 Americans now have health insurance, more than at any time in history. But progress is incomplete, and the future far from certain. Millions remain uninsured. Quality is still uneven. Costs are high and trending up again. Medicare’s insolvency is two years closer, now projected in 2028. Every family has a stake.

___

WHERE THEY STAND

Hillary Clinton would stay the course, making adjustments as needed to major government health insurance programs. She’d build on President Barack Obama’s health care law, with one exception — a tax on generous coverage that she’d repeal. Medicare would get new legal powers to negotiate prescription drug prices with pharma companies. Clinton would also offer some relief from rising out-of-pocket costs, like deductibles and copayments.

Donald Trump would repeal “Obamacare.” But a recent study found his plan would make 18 million people uninsured. Stay tuned, because Trump has also said he doesn’t want people “dying on the street.” Similar to Clinton, he has promised not to cut Medicare. He agrees Medicare should be able to negotiate drug prices, unusual for a Republican. Trump’s campaign has said he may revisit major health care programs once in the White House.

___

WHY IT MATTERS

Patients from all over the world come to America for treatment. U.S. research keeps expanding humanity’s ability to confront disease. But the U.S. still spends far more than any advanced country, and its people are not much healthier.

Obama’s progress reducing the number of uninsured may be reaching its limits. Premiums are expected to rise sharply in many communities for people covered by his namesake law, raising concerns about the future.

The health care overhaul did not solve the nation’s longstanding problem with costs. Total health spending is picking up again, underscoring that the system is financially unsustainable over the long run. Employers keep shifting costs to workers and their families.

No one can be denied coverage anymore because of a pre-existing condition, but high costs are still a barrier to access for many, including insured people facing high deductibles and copayments. Prescription drug prices — even for some generics — are another major worry.

The 2016 election offers a choice between a candidate of continuity — Clinton — and a Republican who seems to have some core beliefs about health care, but lacks a coherent plan.

If the presidential candidates do not engage the nation in debating the future of health care, it still matters.

Even if you’re healthy, deeper national debt affects the economy and in some way everyone’s standard of living, especially the next generation. If the government has to spend more on health care, it comes at the expense of more debt, cuts in something else or higher taxes.

America’s problem with health care spending can’t be ignored or wished away. Political leaders can postpone hard choices, but that will mean consequences even more wrenching when the bill comes due.